By Dr. Mercola
In the U.S., more than 2 in 3 adults are either overweight or obese, while 1 in 13 is considered to have extreme obesity.1 As obesity rates have risen so, too, have obesity-related diseases like cancer, Type 2 diabetes, high blood pressure and osteoarthritis. It’s still commonly believed that the best way to lose weight is to simply eat less and exercise more, but this health dogma fails for many, in large part because of an emphasis placed on low-fat, high-carb foods and counting calories.
As a result, people struggling with obesity may turn to extreme measures like bariatric surgery as a last resort to lose weight. A misguided article in The Atlantic even went so far as to call bariatric surgery the “obesity cure” and scold states with some of the highest rates of obesity for not covering the sometimes-deadly medical procedure in their Medicaid programs.2 If you’re currently trying to lose weight, please understand that there is a better way.
Bariatric Surgery Is Not an ‘Obesity Cure’
Bariatric surgery costs tens of thousands of dollars, making it inaccessible for many people if the procedure isn’t covered by their insurance. This may be a blessing in disguise, however, as complications, from bleeding and infection to blood clots and death, can and do occur. Nonetheless, The Atlantic called out Mississippi — the state with the second-highest rate of obesity in the U.S. — and Montana as being the only two states that don’t cover bariatric surgery in their Medicaid programs.
Many other states don’t cover the surgery in their state employee plans, and even when coverage is offered, there may be barriers that make qualifying for the surgery difficult, such as a requirement to quit smoking or lose a certain amount of weight first. But the solution to Mississippi’s 37 percent obesity rate isn’t surgery to shrink the stomach, which is merely an invasive Band-Aid that puts your long-term health at risk. There are three primary types of weight loss surgery:3
- Laparoscopic adjustable gastric band: This involves placing a ring around your stomach, which makes you feel full faster. An inflatable balloon is attached to the band that can be adjusted in size to change the size of your stomach pouch.
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- Gastric sleeve: This surgery involves removing most of your stomach, leaving only a banana-shaped portion that’s closed with staples. In addition to physically reducing the amount of food you can eat, the removal of part of your stomach alters your gut hormones and gut bacteria, which play a role in appetite and metabolism.
- Gastric bypass: In addition to stapling your stomach so only a small pouch remains in the upper section, gastric bypass involves cutting your small intestine and attaching it to the stomach pouch. By bypassing most of your stomach and upper part of your small intestine, your body absorbs fewer calories when you eat, but the surgery will also alter your gut hormones and bacteria.
In a review of 164 studies, bariatric surgery was found to be effective in helping people lose weight and keep it off as well as reduce rates of obesity-related health problems.4 However, “risks of complication, reoperation and death exist,” the researchers noted. The study found a complication rate of 17 percent, whereas another 7 percent required a second surgery.
In addition to the risk of infection or leaking from the areas of the stomach that have been stapled, bariatric surgery can make it difficult for you to absorb nutrients from the food you eat, leading to related health problems like anemia and osteoporosis. Gallstones can also develop, and many patients are prescribed gallstone prevention medication after surgery, whereas gastric bands can also erode into your stomach — a complication that requires removal.
Strictures are another potential problem, which refer to narrowing of the newly shaped stomach or connection between the small intestine and stomach. The narrowing can cause nausea, vomiting and trouble swallowing when you try to eat swallow food, and must be fixed with additional medical procedures. The way your body processes alcohol may also be affected, so patients must be aware that drinking alcohol could be problematic after bariatric surgery.5
Ketogenic Diet: How to Eat to Lose Weight
Bariatric surgery is in no way a cure for obesity; it instead confines you to a lifetime of abnormally restricted eating patterns and risks of complications. A far better option is to learn to eat the way your body needs to lose weight: If you can deal with the restricted eating that’s required following bariatric surgery, you can learn to eat a ketogenic diet, which is the “secret” to healthy weight loss and a true “cure” for obesity.
A ketogenic diet is a dietary approach that focuses on minimal net carbohydrates, moderate amounts of protein and high healthy fat consumption — the three keys to achieving nutritional ketosis. In fact, it’s what I recommend for most people who would like to optimize their health and maintain a healthy weight. A ketogenic diet helps access your body fat so that it can be shed. Obese people in particular can benefit from this method. In one study, obese test subjects were given a low-carb ketogenic diet and a low-fat diet.
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After 24 weeks, researchers noted that the low-carb group lost more weight (9.4 kilograms) compared to the low-fat group (4.8 kilograms).6 Another sstudy also showed that patients following a very low-carb ketogenic diet lost more weight than those following a low-fat diet, making it “an alternative tool against obesity.”7 Unfortunately, a high-carb, low-fat diet is usually recommended for people who are trying to lose weight, which is counterproductive and a prime culprit in creating the obesity epidemic that we’re facing today.
A ketogenic diet will help you optimize your health by converting from burning carbohydrates for energy to burning fat as your primary source of fuel. My book, “Fat for Fuel,” explains the many metabolic advantages you gain once your body regains the ability to burn fat for fuel. When your body burns primarily carbs for fuel, excessive reactive oxygen species (ROS) and secondary free radicals are created, which damage cellular mitochondrial membranes and DNA, leading to the degenerative diseases that are so prevalent today.
Healthy dietary fats, which are a cleaner-burning fuel, create far fewer ROS and free radicals. This lays the groundwork for many of the metabolic benefits of this program. Fats are also critical for the health of cellular membranes and many other biological functions. The only “side effects” of a ketogenic diet are beneficial ones, like a reduced risk of Type 2 diabetes8 and other chronic diseases and even a reduced appetite.9
Adding Intermittent Fasting Can Increase Your Weight Loss Results
Losing weight isn’t about calorie counting so much as it is about choosing the right calories and consuming them at the proper frequencies. I recommend limiting your eating to two meals per day, either breakfast/lunch or lunch/dinner, within a six- to eight-hour window each day. This meal timing is a form of intermittent fasting, as by eating all your meals within a certain span of time each day, you end up fasting daily as well. Longer water fasts also offer powerful health benefits, although you need to work your way into them.
One strategy I’ve found to be extremely helpful is to gradually increase the time of your daily intermittent fasting until you’re fasting 20 hours a day. After about a month of this, doing a four- or five-day-long water fast will not be nearly as difficult, as you’re already used to not eating for extended periods. Importantly, water fasting activates autophagy, allowing your body to clean itself out, and triggers the regeneration of stem cells.
Remarkably, whereas low-calorie dieting will cause morbidly obese people to develop skin folds that must be surgically removed after significant weight loss, this typically does not occur when you lose the weight by water fasting.
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Your body actually metabolizes the excess skin as you go along, because it’s in such efficient regeneration mode. In fact, if you’re severely overweight or have Type 2 diabetes, water fasting may be the answer you’ve been looking for. A fasting-mimicking diet has even been shown to reverse diabetes in animal studies.10
What You Need to Get Started
If you’re obese, you cannot guess when it comes to the amount of fat, net carbs and protein you eat to follow a ketogenic diet. In the beginning, I highly recommend measuring and tracking them using:
- A kitchen scale to weigh food items
- Measuring cups to measure food amounts
- A nutrient tracker. I recommend using www.cronometer.com/mercola, as it is the most accurate nutrient tracker available, it’s free and it’s already set up for nutritional ketosis
Based on the personal base parameters you enter, such as height, weight, body fat percentage and waist circumference, it will automatically calculate the ideal ratios of net carbs, protein and healthy fats (including your omega-3 to omega-6 ratio) to put you into nutritional ketosis. To start, you’ll need to avoid processed foods as well as those that contain high amounts of carbohydrates, such as milk, as they may cause you to consume more than the allotted amount of carbs that you need for a day.
You’ll want to consume high amounts of fiber, preferably from green leafy vegetables such as broccoli, spinach, kale and parsley, and nonstarchy vegetables, along with plenty of healthy fats, such as:
In my view, the single most important driver of obesity is consuming over 50 grams of net carbs (carbohydrates minus the fiber) a day and excessive protein. Once you get net carbs below 50 grams, moderate your protein intake to 0.5 gram per pound of lean body weight, along with higher amounts of high quality fat, your body will start to regain its ability to burn fat as its primary fuel. Once you become an efficient fat burner, it will become virtually impossible to be overweight.
Once you are burning fat for fuel, you’ll need to cycle healthy carbs back in to feed your gut microbes and ensure healthy insulin functioning. After a day or two of “feasting,” you then cycle back into nutritional ketosis (the “fasting” stage) for the remainder of the week. By periodically pulsing higher carb intakes, consuming, say, 100 or 150 grams of carbs opposed to 20 to 50 grams per day, your ketone levels will dramatically increase and your blood sugar will drop.
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Exercise Complements a Ketogenic Diet
Your diet is the most important factor in losing weight, but once you’ve gotten the hang of following a ketogenic diet, exercise will also be important. High-intensity interval training (HIIT), which research has shown to offer greater fitness and health gains in a fraction of the time compared to typical moderate or low-intensity gym workouts, may be particularly beneficial.
In a study of overweight and obese adults, HIIT and moderate-intensity continuous training led to similar improvements in body composition over 10 weeks, but HIIT required about 40 percent less training time to receive those benefits.11 If you’re obese, the nitric oxide dump is an excellent starting point that can help you to improve your mitochondrial health in just three or four minutes three times a day.
By combining HIIT with a ketogenic diet and regular daily movement (limiting your sitting time as much as possible), weight loss will be the natural result of rebalancing your body’s chemistry.
And unlike bariatric surgery, which puts you at risk of serious infections, additional medical procedures and death, losing weight via a ketogenic diet will slash your risk of other chronic diseases while increasing your longevity. You’ll shed excess weight and be healthier for the long run, making it a true obesity cure that can work for virtually everyone.
Sources and References
- 1 National Institute of Diabetes and Digestive and Kidney Diseases, Overweight & Obesity Statistics
- 2 The Atlantic May 7, 2018
- 3 National Institute of Diabetes and Digestive and Kidney Diseases, Types of Bariatric Surgery
- 4 JAMA Surg. 2014 Mar 1; 149(3): 275–287.
- 5 National Institute of Diabetes and Digestive and Kidney Diseases, Bariatric Surgery Side Effects
- 6 Ann Intern Med. 2004;140(10):769-777.
- 7 Br J Nutr. 2013 Oct;110(7):1178-87.
- 8 Nutr Metab (Lond). 2008; 5: 36.
- 9 Obesity (Silver Spring). 2007 Jan;15(1):182-7.
- 10 Cell. 2017 Feb 23;168(5):775-788.e12.
- 11 Obes Rev. 2017 Jun;18(6):635-646.
